维立西呱联合托伐普坦治疗左室射血分数降低型慢性心力衰竭急性加重临床观察  

The Efficacy of Verapamil Combined with Tolvaptan in the Treatment of Acute Exacerbation of CHF and its Effects on Myocardial Inflammation and Fibrosis

作　　者：周博文 户学敏[1] 闫宜亮 刘进军[2] ZHOU Bowen;HU Xuemin;YAN Yiliang;LIU Jinjun(The First People's Hospital of Suzhou,Suzhou,Anhui,China 234000;The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui,China 233000)

机构地区：[1]安徽省宿州市第一人民医院,安徽宿州234000 [2]蚌埠医学院第一附属医院,安徽蚌埠233000

出　　处：《中国药业》2025年第6期90-95,共6页China Pharmaceuticals

基　　金：安徽省宿州市自筹资金项目[SZZCZJ202206]。

摘　　要：目的探讨维立西呱联合托伐普坦治疗左室射血分数(LVEF)降低型慢性心力衰竭(CHF)急性加重的临床疗效及对患者心肌炎症和纤维化的影响。方法选取宿州市第一人民医院2020年4月至2023年4月收治的LVEF降低型CHF患者292例,按随机数字表法分为对照组(给予托伐普坦治疗)、观察组(给予维立西呱联合托伐普坦),各146例,进行单盲前瞻性随机对照试验,两组疗程均为4周。结果观察组总有效率为96.58%,明显高于对照组的82.19%(P<0.05)。与对照组比较,观察组患者治疗1,4周后的简化估算肾小球滤过率(eGFR)、24 h尿量明显增加,尿微量白蛋白(U-mAlb)、尿β_(2)-微球蛋白(β_(2)-MG)水平明显降低(P<0.05);N末端脑钠肽前体(NT-proBNP)水平明显降低(P<0.05),每搏输出量(SV)、LVEF明显升高(P<0.05);中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、单核细胞与高密度脂蛋白胆固醇比值(MHR)、C反应蛋白(CRP)、白细胞介素1β(IL-1β)水平明显降低(P<0.05);透明质酸(HA)、转化生长因子-β_(1)(TGF-β_(1))、Ⅲ型前胶原(PCⅢ)、结缔组织生长因子(CTGF)水平明显降低(P<0.05)。观察组再住院率为1.38%,明显低于对照组的14.38%(P<0.05)。结论维立西呱与托伐普坦的联合治疗,能改善患者的心肾功能,抑制炎性反应和心肌纤维化,降低再入院率,提高疗效。Objective To study the efficacy of verapamil combined with tolvaptan in treating acute exacerbation of chronic heart failure with reduced left ventricular ejection fraction,and its impacts on myocardial inflammation and fibrosis.Methods 292 patients with acute exacerbation,admitted from April 2020 to April 2023,were selected for a single-blind,prospective,randomized controlled trial.They were randomly divided by computer into a tolvaptan group(tolvaptan treatment)and a combined group(verapamil+tolvaptan treatment),with 146 patients in each group.The treatment lasted 4 weeks.Results Thge total effective rate in the observation group was 96.58%,which was significantly higher than 82.19%in the control group(P<0.05).Compared with the control group,the eGFR and 24-hour urine volume increased significantly in the observation group(P<0.05).U-mAlb andβ_(2)-MG decreased significantly in the observation group at 1 and 4 weeks after treatment(P<0.05).NT-proBNP decreased significantly in the observation group at 1 and 4 weeks after treatment(P<0.05).SV and LVEF increased significantly in the observation group at 1 and 4 weeks after treatment(P<0.05).NGAL,MHR,CRP,and IL-1βdecreased significantly in the observation group at 1 and 4 weeks after treatment respectively(P<0.05).HA,TGF-β_(1),PCⅢ,and CTGF decreased significantly in the observation group 1 and 4 weeks after treatment(P<0.05).The re-hospitalization in the observation group was 1.38%,which was significantly lower than 14.38%in the control group(P<0.05).Conclusion The combination of vericiguat and tolvaptan exerts cardiorenal protective effects by inhibiting inflammatory pathways and myocardial fibrosis,thereby reducing rehospitalization risk and improving clinical outcomes.

关 键 词：维立西呱 托伐普坦 左室射血分数降低型慢性心力衰竭 急性加重 心功能 炎性反应 心肌纤维化 

分 类 号：R969.4[医药卫生—药理学]